What strategies should be used for the implementation, management, and governance of health IT systems?

Please respond to these 4 postings:
1. We have a dollar tree and Walmart a couple of miles away from our house. I reside in Hudson, Ma, which has a median income of 82k in 2018, above the average annual income of 65K across the rest of the united states. Having access to supplies from Walmart and dollar tree is an opportunity for numerous people who cannot afford and keep up with the inflation of the commodities. The food itself in Walmart is cheap, but the food quality is not fresh. Within the past year, there has been a rapid rise in consumption of dairy products leading to an increase in dairy product prices by 2.5 %, and beef, fish, and other meats are to increase by 2.5%- 3.5 %(Eira, 2020).
Having Walmart or dollar tree reveals the finances of the average American. Yearly, On average, 48 million Americans shop at Walmart, and 75 % shop due to the low prices Majority of the shoppers use SNAP benefits. Since 2014 the number of monthly benefits was lowered by 38$, which adds a burden to struggling people and living by weekly paychecks( Heller, 2014). Cheaper foods don’t necessarily mean they are healthy, and the prices are $1.50 higher than unhealthy foods. So people automatically divert to something more reasonable and affordable to stay within the budget( Eira, 2020).
References
Eira, A. (2020, April 15). Number of Walmart Stores in the US in 2020: Demographics, Statistics, and Predictions. Financesonline.com. https://financesonline.com/number-of-walmart-stores-in-the-us/
Heller, L. (2014). Walmart Just Revealed How Poor U.S. Shoppers Are. Forbes. https://www.forbes.com/sites/lauraheller/2014/03/28/walmart-just-revealed-how-poor-u-s-shoppers-are/?sh=4bb512ce1f75
2. I was not able to make it to my nearest family dollar however, I was able to look up surrounding food places located within a 5-mile radius. What I found was that the foods offered at family dollar were mostly processed and high in fat, sugar and carbohydrates. There are little no selection of vegetables with the exception of a few that may be within high-processed frozen foods. The family dollar in Humble, Texas is located in a shopping center with both sit-down and fast-food restaurants. There is also a Walmart and Costco within minutes of this shopping center where food can be purchased.
The pros of the dine-in restaurants are that they offer healthier selections of food. Cons are that these restaurants are more expensive and consume more time in comparison to the fast-food restaurants located nearby. While the Chic-Fil-A nearby offers fried and unhealthy food options, they also offer healthy alternatives such as grilled chicken breast, grilled nugget, and side salads in lieu of French fries. The option of having a Chic-Fil-A nearby is a great option for those with limited time, who still wish to eat healthier diets. Other fast-food locations offer similar to the foods offered at the local family dollar in that they are quick, but do not offer a lot of nutrition. Costco and Walmart both offer a wide array of food selections. Cons are that the majority of these foods need to be cooked. Also, to purchase foods at Costco, you have to purchase a membership potentially making this selection less than ideal for those trying to bargain shop.
3. What strategies should be used for the implementation, management, and governance of health IT systems? What resources should be considered (e.g., risks, assumptions, limitations, costs, etc.)? Explain each answer.
Bigdeli et al. (2020) makes the point that governances should be part of the Health Systems Governance Framework which includes policy makers, health service providers, and people. The strategy to use for this framework would to be all inclusive. Welcome policy makers of all disciplines to look at the health IT system and what can be put into place to make improvements on what types of policies need to be in place. Having providers from for profit and non- profit, as well as critical care, acute care and supportive clinical staff would give insight into what changes the system needs so that it is the fastest and the most effective system. Having the people who are benefiting from this system involved would make a huge step towards getting them involved in their healthcare and improving patient outcomes.
Resources to consider should be limitations of the government to overreach into the health IT system and use it to attack people or a system. Cost is a resource that needed to always be considered because it affects who can access the ability to get the system. A resource that also needs to be considered is the team that is going to take over the maintenance of the health IT system and the organization that will put limitations and cost saving measures on them without compromising safety of the system.
Bigdeli M, Rouffy B, Lane BD, et al. Health systems governance: the missing links. BMJ Global Health 2020;5:e002533. doi:10.1136/ bmjgh-2020-002533
4. A clinical decision support system (CDSS) improves healthcare delivery by enhancing medical decisions with targeted clinical knowledge, patient information, and other health information. A traditional CDSS comprises software designed to be a direct air to clinical-decision making. The characteristics of an individual patient are matched to a computerized clinical knowledge base. Patient-specific assessments or recommendations are primarily used at the point-of-care, for the clinician to combine their knowledge with information or suggestions provided by the CDSS (Sutton, 2020).
To manage and govern such systems, it needs to facilitate a scheduled review, methods for acquiring and implementing new knowledge, and streamlined processes for gathering physician feedback on the system and training users on why particular data entry and standardization of data entry practices. It is essential to identify changes in performance and use over time. In addition, the quality of the data repository should be monitored. It is also necessary to ensure that conclusions are not made beforehand on corrupted or poor-quality data (Sutton, 2020).
To provide a verifiable source of information to the user on why the recommendation exists. In addition to increasing trust, this may guide users to update their knowledge if they are unaware of the offer. Many systems also query reasons for not following advice to elucidate the source of mistrust. This is a good idea but should not be mandatory or ‘bulky’ in design (Sutton, 2020).
Reference
Sutton, R., Pincock, D., Baumgat, D.C., Sadowski, D.C., & Fedorak, R.N. (2020) An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ digital medicine, 3(1).

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